Provider Demographics
NPI:1881601904
Name:SENIOR CARE OF PENSACOLA L.C.
Entity type:Organization
Organization Name:SENIOR CARE OF PENSACOLA L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-476-5131
Mailing Address - Street 1:1015 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7055
Mailing Address - Country:US
Mailing Address - Phone:850-476-5131
Mailing Address - Fax:
Practice Address - Street 1:1015 VERNON ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7055
Practice Address - Country:US
Practice Address - Phone:850-476-5131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL71193104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness